Tuberculosis Flashcards
Isoniazid: Dosage form? Dose? Metabolism? Toxicities?
Dosage form: Oral, IM, IV
Dose: 300 mg QD // 10-20 mg/kg for kids
Cleared liver more than kidney
Toxicities: Hepatotoxicity, peripheral neuropathy
Rifampin: Dosage form? Dose? Metabolism? Toxicities?
Dosage form: Oral, IV
Dose: 600 mg QD // 10-20 mg/kg for kids
Cleared liver more than kidney
Toxicities: hepatotoxicity, flu-like syndrome
Rifapentine: Dosage form? Dose? Metabolism? Toxicities?
Dosage forms: Oral only
Dose: 600 mg QD // moving to 1200 mg QD
Cleared by liver more than kidney
Toxicities: hepatotoxicity, flu-like syndrome
Rifabutin: Dosage form? Dose? Metabolism? Toxicities?
Use for HIV+ patientsA
Dosage forms: oral
Dose: 300 mg (150-450 mg) QD
Metabolism: Liver more than kidneys
Toxicities: Neutropenia, thrombocytopenia, uveitis
Which rifamycin is best for someone on a lot of drugs?
Rifabutin - least amount of CYP3A4 induction
Pyrazinamide: Dosage form? Dose? Metabolism? Toxicities?
Dosage form: Oral
Dose: 35-40 mg/kg QD (adults and kids)
Cleared by liver, then metabolites are cleared by kidneys
Toxicities: Hepatotoxicity, elevated uric acid
How can you tell a patient is non-adherent on PZA?
If their uric acid is normal, they’re not being adherent. PZA causes uric acid levels to rise.
Ethambutol: Dosage form? Dose? Metabolism? Toxicities?
4th drug in case of resistance
Dosage: oral
Dose: 15-25 mg/kg QD (adults and kids)
Cleared: KIDNEYSSSS over liver
Toxicity: Ocular toxicity, rashes
What drug should be adjusted renally?
Ethambutol, Streptomycin, levofloxacin, cycloserine
Streptomycin: Dosage form? Dose? Metabolism? Toxicities?
Role: Fourth drug in case of resistance
Dosage: IM, IV
Dose: 12-15 mg/kg QD (adults and kids)
Cleared: Kidneys
Toxicity: Ototoxicity, nephrotoxicity, cation loss
Amikacin, Kanamycin, Capreomycin - role?
Drug resistant TB
Levofloxacin: Dosage? Dose? Metabolism? Toxicities?
Oral, IV
750 - 1000 mg QD
Kidneys
Toxicities: Dizziness, GI, tendonitis
Moxifloxacin: Dosage? Dose? Metabolism? Toxicities?
Oral, IV
400 mg QD
Kidneys and liver
Dizziness, GI, tendonitis
Ethionamide: Dosage form? Dose? Metabolism? Toxicities?
Drug resistant TB
Oral
250-500 mg BID
10-20 mg/kg divided BID for kids
Cleared by liver
Toxicities: GI upset, hypothyroidism
p-Aminosalicylic Acid: Dosage form? Dose? Metabolism? Toxicities?
Drug resistant TB
Role: Drug resistant TB
Dosage: Oral
Dose: 4000 mg BID-TID // 150 mg/kg divided BID-TID
Cleared liver over kidneys
Toxicities: GI upset, hypothyroidism
Cycloserine: Dosage form? Dose? Metabolism? Toxicities?
Drug resistant TB
Oral
250-500 mg BID // 10-20 mg/kg divided BID for kids
Cleared by kidneys
Toxicities: lack of concentration, altered behavior
First line treatment for latent TB infection?
INH 300 mg QD for 9 months
or
900 mg (15 mg/kg) twice weekly DPOT
Second line treatment for latent TB infection?
Rifapentine 900 mg PLUS INH 900 mg (once weekly for 12 doses)
Third line treatment for latent TB infection?
Rifampin 600 mg QD for 4 months
Could also sub Rifabutin 300 mg (less drug interactions, good for HIV pts)
Fourth line treatment for latent TB (INH & RIF resistant suspected)?
Ethambutol 15 mg/kg QD plus Levo 750 mg QD for 6-12 months
or
PZA 25 mg/kg QD + Levo 750 mg QD for 6-12 months (not well tolerated)
How to treat active disease?
For drug-susceptible TB (60 kg male)
For first 8 weeks:
Isoniazid 300 mg 5x weekly (5 mg/kg)
Rifampin 600 mg 5x weekly (10 mg/kg)
Pyrazinamide 1500 mg 5 x weekly (25 mg/kg)
plus
Ethambutol 1200 mg 5 x weekly (20 mg/kg) until TB drug-susceptibility documented
then Isoniazid 300 mg 5 x weekly (5 mg/kg) and Rifampin 600 mg 5 x weekly (10 mg/kg) for at least 4 more months (6 months total)
Drop the PZA and Ethambutol
Duration of treatment for active TB infection?
Uncomplicated: 6 months total at least
HIV: Extend therapy to 9 months if they have a positive culture at 2 months or delayed clinical response to therapy
Meningitis: 9-12 months
Bone TB: 6-9 months
How to treat MDR TB?
No standard or twice weekly regimens, treat for 18 to 30 months, DPOT essential
What TB drugs are CYP3A4 inducers?
Rifampin, rifapentine, rifabutine
